Defining risk for infectious complications on extracorporeal life support

Little is known about potentially modifiable risk factors associated with infectious complications (IC) acquired during extracorporeal life support (ECLS).

The Extracorporeal Life Support Organization registry was accessed, and data on patient demographics, run characteristics, infections, and outcomes were collected. Patients who developed IC while on ECLS were compared to those that did not. Regression analysis was performed. Results are expressed as odds ratios, with P < .05 considered significant.

Infectious complications developed in 10.2% of 38,661 patients and was associated with increased odds of death. Risk factors for IC included increasing age, diagnosis, more remote decade, complications, presence of multiple complications, and ECLS mode. The risk of IC increased with the number of complications (P < .001). Patients with positive cultures before ECLS also had increased odds of IC (OR 2.12, 95% CI 1.92-2.34, P < .001). Those with IC were more likely to have cultures grow aggressive organisms (non-lactose fermenting gram negative rods, methicillin resistant Staphylococcus aureus, and fungi).

Strategies to reduce IC while on ECLS should be aimed at prevention of complications and treatment of pre-existing infections. Future studies should address whether broader spectrum antibiotic prophylaxis and/or empiric coverage for suspected sepsis is indicated in ECLS patients.